374

BROKEN BONES.

upon his face, and during the extension the head of the bone mustbe pushed inward.

Dislocations of the knees, ancles, and toes, are reduced much inthe same manner as those of the upper extremities, viz. by makingan extension in opposite directions, while the operator replaces thebones. In many cases, however, the extension alone is sufficient,and the bone will slip into its place merely by pulling the limbwith sufficient force. It is not hereby meant, that force alone issufficient for the reduction of dislocation. Skill and address willoften succeed better than force. I have known a dislocation ofthe thigh reduced by one man, after all the force that could be usedby six had proved ineffectual.

When the force of the muscles in very robust persons resistsevery effort to reduce a dislocated limb, a grain or two of emetictartar dissolved in water may be administered, and taking advan-tage of the general languor and debility that precedes the act ofvomiting, the Jimb may be reduced with facility. I have knownthis plan successfully practised ; to which may be added bleedingand the warm bath.

CHAP. III.

OF BROKEN BONES, &c.

There is, in most country-villages, some person who prétends tothe art of reducing fractures. Though in general such personsare very ignorant, yet some of them are very successful ; whichevidently proves, that a small degree of learning, with a sufficientshare of common sense and a mechanical head, will enable a manto be useful in this way. We would, however, advise people neverto employ such operators, when an expert and skilful surgeon canhe had ; but when that is impracticable, they must be employed :we shall therefore recommend the following hints to their consid-eration :—

When a large bone is broken, the patient's diet ought in all re-spects to be the same as in an inflammatory fever. He shouldlikewise be kept quiet and cool, and his body open by emollientclysters ; or, if these cannot be conveniently administered, by foodthat is of an opening quality ; as stewed prunes, apples boiled inmilk, boiled spinage, and the like. It ought, however, to be hereremarked, that persons who have been accustomed to live high arenot all of a sudden to be reduced to a very low diet. This mighthave fatal efl'ects. There is often a necessity for indulging evenbad habits in some measure, where the nature of the disease mightrequire a difterent treatment.

It will generally be necessary to bleed the patient immediatelyafter a fracture, especially if he be young, of a full habit, or hasat the same time received any bruise or contusion. This opera-tion should not only be performed soon after the accident happens,but, if the patient be very feverish, it may be repeated next day.When several of the ribs are broken, bleeding is peculiarly neces-sary.